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Hyperkalemia

Hyperkalemia (hyper is high, kalium is the Latin name for potassium) is an elevated blood level (above 5.0 mmol/L) of the electrolyte potassium. Extreme degrees of hyperkalemia are considered a medical emergency due to the risk of potentially fatal arrhythmias. more...

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Signs and symptoms

Symptoms are fairly nonspecific, and generally include malaise and muscle weakness; mild breathlessness may indicate metabolic acidosis, one of the settings in which hyperkalemia may occur. Often, however, the problem is detected during screening blood tests for a medical disorder, or it only comes to medical attention after complications have developed, such as cardiac arrhythmia or sudden death.

During the medical history taking, a doctor will dwell on kidney disease and medication use (see below), as these are the main causes. The combination of abdominal pain, hypoglycemia and hyperpigmentation, often in the context of a history of other autoimmune disorders, may be signs of Addison's disease, itself a medical emergency.

Diagnosis

In order to gather enough information for diagnosis, the measurement of potassium needs to be repeated, as the elevation can be due to hemolysis of the material in the first sample. Generally, blood tests for renal function (creatinine, blood urea nitrogen), glucose and occasionally creatine kinase and cortisol will be performed. Calculating the trans-tubular potassium gradient can sometimes help in distinguishing the cause of the hyperkalemia.

Electrocardiography (ECG) is generally done early to identify any influences on the heart. High, tent-shaped T-waves, a small P wave and a wide QRS complex (that becomes sinusoidal) all identify the influence of excess potassium on the heart. This finding alone is an important reason for treatment, as it may forewarn ventricular fibrillation.

Often arterial blood gas measurements and renal ultrasound will be performed.

Differential diagnosis

Causes include:

Ineffective elimination from the body

  • Renal failure
  • Medication. Medication that can cause hyperkalemia (most are antihypertensives):
    • ACE inhibitors
    • Potassium-sparing diuretics (e.g. amiloride and spironolactone)
    • Angiotensin receptor blockers
    • Succinylcholine (also known as suxamethonium, a paralytic used in anesthesia)
  • Metabolic acidosis
  • Mineralocorticoid deficiency or resistance (many types)
    • Addison's disease
    • Aldosterone defiency
    • Congenital adrenal hyperplasia
  • Liddle syndrome, pseudohypoaldosteronism, other defects of renal tubular K excretion

Excessive release from cells

  • Rhabdomyolysis, burns or any cause of rapid tissue necrosis, including tumor lysis syndrome
  • Massive blood transfusion or massive hemolysis
  • Insulin deficiency

Excessive intake

  • Intoxication (potassium-containing dietary supplements or salt replacement)

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Quantum Sufficit : Just Enough - alpha-hydroxy acid; borderline Pap test results; large amounts of fruit juice can cause hyperkalemia; computer use and
From American Family Physician, 8/15/01 by Sarah Morgan

* "Alpha-hydroxy-acid? What is that? And is it really good for skin?" A Web site on cosmetics produced by the Food and Drug Administration reports that many of the compounds found in skin care products can cause more problems than they cure. While alpha-hydroxy acids are added to skin creams to reduce the signs of aging, they can also increase the skin's sensitivity to the sun. Without adequate protection, a person using them is more likely to burn, even if the product hasn't been used for a day or two.

* Borderline Pap test results may no longer be a "what next?" situation. A study in the Journal of the National Cancer Institute shows that a second test for human papillomavirus (HPV) infection allows doctors to identify 96.3 percent of the women who do, and those who don't, need treatment. HPV, a sexually transmitted disease, causes most cases of cervical cancer.

* While fruit juice is good for your health in small amounts, a case report in The Lancet shows that too much of a good thing can be bad. In this case, a patient was admitted to a hospital twice in a few weeks with hyperkalemia. Although he had mild renal failure and was being treated with lisinopril, it was unclear to doctors why his potassium level was high. His renal failure was stable, and he had been taking an ACE inhibitor for more than two years. It wasn't until the patient's daughter happened to mention that he recently had been drinking large quantities of apple juice with added potassium that the cause of the imbalance was discovered.

* "Well, there goes that excuse for not working." A study published in Neurology shows that using a computer at work doesn't increase your chances of developing carpal tunnel syndrome. Employees who perform most of their work on a computer completed a questionnaire on the symptoms of carpal tunnel syndrome. While 30 percent of those surveyed reported having experienced symptoms of carpal tunnel syndrome, further testing confirmed that only 3 percent had the syndrome.

* Been flying a lot lately? You may be experiencing brain drain. A study at the University of Bristol in England shows that frequently jetting between multiple time zones may damage the brain's cognitive functioning. As reported on TIME.com, researchers found that airline attendants given five days or fewer in their home time zone to recover performed worse on reaction time and vision tests. They also showed a decrease in the size of the right temporal lobe. Scientists believe the brain needs 10 days to recover from multiple time zone hopping.

* Here's another weapon in the fight against cardiovascular disease: measure children's blood pressure annually to prevent future risk. According to an article in the American Journal of Hypertension, the rising trend in childhood obesity may indicate a cardiovascular disease epidemic in the future. The authors of the article suggest that annual blood pressure checks during childhood can show upward trends of blood pressure and may be indicative of future adult risk. They warn, however, that physicians should measure a child's blood pressure on several occasions before making a diagnosis of hypertension. This helps assure a correct diagnosis and the start of a treatment plan, if needed.

COPYRIGHT 2001 American Academy of Family Physicians
COPYRIGHT 2001 Gale Group

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